<div class="form">
    <h3>Register Newsletter</h3>
    <form method="post" action="<?php echo $this->action ?>" id="newsletter-form">
        <div class="row">
            <input type="text" name="email" id="newsletter-email" placeholder="Sign up to our newsletter" />
        </div>
        <div class="row">
            <input type="submit" value="Submit" />
        </div>
    </form>
</div><!-- form -->